臺灣博碩士論文加值系統

本研究的目的是利用心率變異的分析，來比較吸入性麻醉劑sevoflurane與isoflurane及靜脈麻醉劑propofol與tiletamine-zolazepam對未經麻醉前給藥的貓隻自主神經的影響。心率變異主要是分析心跳過程中，心跳與心跳間的變化，以一種非侵入性的方式來了解動物體自主神經系統的變化。本實驗主要測量六隻健康混種貓隻在清醒及不同麻醉濃度時的心電圖訊號，再將此訊號利用電腦軟體進行快速傅力葉轉換進行心率變異計算，可以分析出不同的頻率範圍，低頻 (low frequency；LF) 及高頻 (high frequency；HF)。在吸入性麻醉劑的結果方面，貓隻使用sevoflurane麻醉在1倍MAC時，會使LF及HF較清醒時下降，而隨著麻醉濃度增加至2倍MAC，LF及低頻功率比 (LF power in normalized units；LF norm) 則較1倍MAC時上升，顯示sevoflurane麻醉會抑制貓隻交感及副交感神經的活性，而隨著麻醉濃度的增加，則對交感神經及副交感神經的抑制程度減少；而以isoflurane麻醉則會使LF及HF皆有下降的情形，顯示isoflurane會抑制貓隻交感及副交感神經的活性。在靜脈麻醉劑方面，propofol麻醉則會造成HF的下降及LF norm的上升，顯示propofol會使貓隻交感神經的活性增加及抑制貓隻副交感神經的活性；單次劑量給予tiletamine-zolazepam在麻醉30分鐘時會使LF及HF下降，隨著麻醉時間的增加 (麻醉60分鐘) 則會使LF上升，顯示tiletamine-zolazepam在麻醉30分鐘時使交感及副交感神經的活性下降，隨著麻醉時間的延長 (麻醉60分鐘)，則對於自主神經系統抑制的程度減低。另外在麻醉時生理狀態的結果方面，在深度麻醉 (2倍MAC) 時，以isoflurane麻醉的血壓較sevoflurane麻醉顯著降低；以propofol進行麻醉維持則會造成呼吸速率的下降；單次劑量給予tiletamine-zolazepam在麻醉60分鐘時會造成心跳速率的顯著上升。由以上結果顯示，對可能患有心血管相關疾病的貓隻使用sevoflurane麻醉會較isoflurane麻醉為佳；對於有呼吸系統疾病或是心肺功能較差的貓隻不建議使用propofol進行麻醉維持；若給予單次劑量的tiletamine-zolazepam則建議使用於短時間的麻醉。

The aim of this study is to compare the effects of sevoflurane and isoflurane as well as propofol and tiletamine-zolazepam on autonomic nervous regulation in unpremedicated cats by analyzing heart rate variability (HRV). HRV analysis is to characterize beat-to-beat change in heart rate, in other words, a non-invasive way of assessing autonomic nervous regulation. In this study, we recorded electrocardiogram (ECG) data of six healthy mixed cats during awake and different anesthesia states. These ECG signals were underwent fast Fourier transform algorithm to obtain the data of HRV by personal computer. The power spectra of HRV were divided into two frequency range: the low-frequency range (0.04-0.15 Hz; LF) and the high-frequency range (0.15-0.4 Hz; HF). The results of inhaled anesthesia group (sevoflurane isoflurane) showed that, first, under lighter (1xMAC) anesthesia, sevoflurane reduced both LF and HF, but isoflurane decreased both LF and HF, second, under deeper (2xMAC) anesthesia, sevoflurane increased LF and LF norm than 1xMAC but isoflurane decreased both LF and HF. Our findings indicated under lighter (1xMAC) anesthesia, sevoflurane suppressed both sympathetic and parasympathetic nervous activity but less under deeper (2xMAC) anesthesia. Isoflurane suppressed both sympathetic and parasympathetic nervous activity whether under lighter or deeper anesthesia. The results of intravenous anesthesia group (propofol and tiletamine-zolazepam) showed that, propofol anesthesia reduced HF and increased LF norm. The results indicated that propofol anesthesia suppressed parasympathetic nervous activity and increased sympathetic nervous activity. Bolus injection of tiletamine-zolazepam decreased LF at 30 minutes, and increased LF at 60 minutes. The results indicated that tiletamine-zolazepam anesthesia suppressed both sympathetic and parasympathetic activity at 30 minutes and suppressed less both sympathetic and parasympathetic activity at 60 minutes. The physiological changes during anesthesia showed that isoflurane anesthesia decreased blood pressure significantly then sevoflurane anesthesia. Maintenance of anesthesia with propofol revealed reduced respiratory rate. Bolus injection of tiletamine-zolazepam increased heart rate at 60 minutes. According to the effects of HRV analysis and physiological data, sevoflurane, better than isoflurane, maybe recommend to use in cats with cardiovascular illness. Maintenance of anesthesia with propofol does not recommend for cats with cardiopulmonary illness or respiratory illness. Bolus injection of tiletamine-zolazepam was suggested the use of anesthesia in a short period of time.

中文摘要 ............................................. i
英文摘要 ............................................. iii
目次 ................................................. v
表次 ................................................. vii
圖次 ................................................. viii
第一章 緒論 .......................................... 1
第二章 文獻探討 ...................................... 3
第一節 吸入性麻醉劑的歷史演進 ................. 3
第二節 吸入性麻醉劑的物理化學特性 ............. 4
第三節 誘導與恢復速度的決定因子 ..................... 5
第四節 吸入性麻醉劑對心肺功能的影響 ................. 6
第五節 靜脈麻醉劑propofol及tiletamine-zolazepam 的物理化學特性 .......................................... 9
第六節 靜脈麻醉劑propofol及tiletamine-zolazepam 對心肺系統的影響 ........................................ 12
第七節 心率變異 ................................ 14
第三章 材料與方法 ............................... 18
第一節 研究問題與研究假設 ...................... 18
第二節 實驗動物 ................................ 20
第三節 實驗設計 ................................ 21
第四節 清醒狀態心率變異的測定 .................. 22
第五節 誘導麻醉及麻醉維持....................... 23
第六節 最小肺泡濃度之測量 ...................... 26
第七節 心率變異分析 ............................ 28
第八節 統計分析 ................................ 29
第四章 研究結果 ................................. 30
第一節 sevoflurane及isoflurane麻醉的最小肺泡濃度 .... 30
第二節 心肺功能的影響 .................... 31
第三節 麻醉劑對心率變異的影響 ............ 33
第五章 討論 ..................................... 34
第一節 sevoflurane與isoflurane對心率變異的影響 ......... 35
第二節 sevoflurane與isoflurane對血壓的影響 ......... 38
第三節 propofol與tiletamine-zolazepam對心率變異的影響............................................... 39
第六章 結論 ..................................... 44
參考文獻 ........................................ 45

林昭傑。探討靜脈麻醉劑Propofol及吸入性麻醉劑Desflurane對心率變異與聽力誘發電位的影響及比較。國立臺灣大學臨床醫學研究所碩士論文。台北。2007。
范嘉麟。Sevoflurane與Isoflurane對未於麻醉前用藥貓隻在面罩誘導、麻醉指數、心肺功能及血液生化影響之比較研究。國立嘉義大學獸醫學系研究所碩士論文。嘉義。2007。
孫國清。年齡，性別以及劑量在手術前給予Midazolam的影響。慈濟大學神經科學研究所碩士論文。花蓮。2005。
蔡依津。犬隻以propofol全靜脈麻醉臨床應用之評估。國立台灣大學獸醫學研究所臨床組碩士論文。台北。2005。
Agelink MW, Majewski TB, Andrich J, Mueck-Weymann M Short-term effects of intravenous benzodiazepines on autonomic neurocardiac regulation in humans: a comparison between midazolam, diazepam, and lorazepam. Crit Care Med 30: 997-1006, 2002.
Akselrod S, Gordon D, Madwed JB, Snidman NC, Shannon DC, Cohen RJ. Hemodynamic regulation: investigation by spectral analysis. Am J Physiol 249: H867-H875, 1985.
Akselrod S, Gordon D, Ubel FA, Shannon DC, Berger AC, Cohen RJ. Power spectrum analysis of heart rate fluctuation: a quantitative probe of beat-to-beat cardiovascular control. Science 213: 220-222, 1981.
Bernard JM, Wouters PF, Doursout MF, Florence B, Chelly JE, Merin RG. Effects of sevoflurane and isoflurane on cardiac and coronary dynamics in chronically instrumented dogs. Anesthesiology 72: 659-662, 1990.
Brearley JC, Kellagher REB, Hall LW. Propofol anaesthesia in cats.
J Small Anim Pract 29: 315–322, 1988.
Br&;uuml;ssel T, Theissen JL, Vigfusson G, Lunkenheimer PP, Van Aken H, Lawin P. Hemodynamic and cardiodynamic effects of propofol and etomidate: negative inotropic properties of propofol. Anesth Analg 69: 35-40, 1989.
Calvert CA. Heart rate variability. Vet Clin North Am Small Anim Pract. 28: 1409-1427, 1998.
Campagna JA, Miller KW, Forman SA. Mechanisms of actions of inhaled anesthetics. N Engal J Med 348: 2110-2124, 2003.
Deutschman CS, Harris AP, Fleisher LA. Changes in heart rate variability under propofol anesthesia: a possible explanation for propofol-induced bradycardia. Anesth Analg 79: 373-377, 1994.
Eger EI. The pharmacology of inhaled anesthetics. Seminars in anesthesia, Perioperative Medicine and Pain 24: 89-100, 2005.
Fleisher LA. Heart rate variability as an assessment of cardiovascular status. J Cardiothorac Vasc Anesth 10: 659-671, 1996.
Galletly DC, Buckley DH, Robinson BJ, Corfiatis T. Heart rate variability during propofol anaesthesia. Br J Anaesth 72: 219-220, 1994.
Galletly DC, Corfiatis T, Westenberg AM, Robinson BJ. Heart rate periodicities during induction of propofol-nitrous oxide-isoflurane anaesthesia. Br J Anaesth 68: 360-364, 1992.
Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Eur Heart J 17: 354-381, 1996.
Hellyer P, Muir WW 3rd, Hubbell JA, Sally J. Cardiorespiratory effects of the intravenous administration of tiletamine-zolazepam to cats. Vet Surg 17: 105-110, 1988.
Hellyer P, Muir WW 3rd, Hubbell JA, Sally J. Cardiorespiratory effects of the intravenous administration of tiletamine-zolazepam to dogs. Vet Surg 18: 160-165, 1989.
Hemmings HC Jr, Perouansky MA. Intravenous anesthetic agents. In: Hemmings HC Jr, Hopkins PM, ed. Foundations of Anesthesia: Basic Sciences for Clinical Practice. 2nd ed. Mosby, Elsevier, 295-321, 2006.
Hikasa Y, Kawanabe H, Takase K, Ogasawara S. Comparisons of sevoflurane, isoflurane, and halothane anesthesia in spontaneously breathing cats. Vet Surg 25: 234-243, 1996.
Hikasa Y, Ohe N, Takase K, Ogasawara S. Cardiopulmonary effects of sevoflurane in cats: comparison with isoflurane, halothane, and enflurane. Res Vet Sci 63: 205-210, 1997.
Hon EH, Lee ST. Electronic evaluation of the fetal heart rate. VIII. Pattern preceding fetal death, further observations. Am J Obstet Gynecol 87: 814-826, 1963.
Huang HH, Chan HL, Lin PL, Wu CP, Huang CH. Time-frequency spectral analysis of heart rate variability during induction of general anaesthesia. Br J Anaesth 79: 754-758, 1997.
Ilkiw JE, Pascoe PJ. Cardiovascular effects of propofol alone and in combination with ketamine for total intravenous anesthesia in cats. Am J Vet Res 64: 913-917, 2003.
Jang HS, Kwon YS, Lee MG, Jang KH. The effect of tiletamine/zolazepam (Tiletamine-zolazepame) combination with xylazine or medetomidine on electroencephalograms in dogs. J Vet Med Sci 66: 501-507, 2004.
Johnson RA, Striler E, Sawyer DC, Brunson DB. Comparison of isoflurane with sevoflurane for anesthesia induction and recovery in adult dogs. Am J Vet Res 59: 478-481, 1998.
Kanaya N, Hirata N, Kurosawa S, Nakayama M, Namiki A. Differential effects of propofol and sevoflurane on heart rate variability. Anesthesiology 98: 34-40, 2003.
Kato M, Komatsu T, Kimura T, Sugiyama F, Nakashima K, Shimada Y. Spectral analysis of heart rate variability during isoflurane anesthesia. Anesthesiology 77: 669-674, 1992.
Komatsu T, Singh PK, Kimura T, Nishiwaki K, Bando K, Shimada Y. Differential effects of ketamine and midazolam on heart rate variability. Can J Anaesth 42: 1003-1009, 1995.
Latson TW, O'Flaherty D. Effects of surgical stimulation on autonomic reflex function: assessment by changes in heart rate variability. Br J Anaesth 70: 301-305,1993.
Lerche P, Grubb TL. Mask induction of anaesthesia with isoflurane or sevoflurane in premedicated cats. J Small Anim Pract 43: 12-15, 2002.
Liehmann L, Mosing M, Auer U. A comparison of cardiorespiratory variables during isoflurane-fentanyl and propofol-fentanyl anaesthesia for surgery in injured cats. Vet Anaesth Analg 33: 158-168, 2006.
M&;auml;enp&;auml;&;auml; M, Penttil&;auml; J, Laitio T, Kaisti K, Kuusela T, Hinkka S, Scheinin H. The effects of surgical levels of sevoflurane and propofol anaesthesia on heart rate variability. Eur J Anaesthesiol 24: 626-33, 2007.
Malan TP Jr, DiNardo JA, Isner RJ, Frink EJ Jr, Goldberg M, Fenster PE, Brown EA, Depa R, Hammond LC, Mata H. Cardiovascular effects of sevoflurane compared with those of isoflurane in volunteers. Anesthesiology 83: 918-928, 1995.
Masaoka S, Lev-Ran A, Hill LR, Vakil G, Hon EH. Heart rate variability in diabetes: relationship to age and duration of the disease. Diabetes Care 8: 64-68, 1985.
Mutoh T, Nishimura R, Kim HY, Matsunaga S, Sasaki N. Cardiopulmonary effects of sevoflurane, compared with halothane, enflurane, and isoflurane, in dogs. Am J Vet Res 58: 885-890, 1997.
Muzi M, Ebert TJ. A comparison of baroreflex sensitivity during isoflurane and desflurane anesthesia in humans. Anesthesiology 82: 919-925, 1995.
Myers GA, Martin GJ, Magid NM, Barnett PS, Schaad JW, Weiss JS, Lesch M, Singer DH. Power spectral analysis of heart rate variability in sudden cardiac death: comparison to other methods. IEEE Trans Biomed Eng 33: 1149-1156, 1986.
Pieper SJ, Hammill SC. Heart rate variability: technique and investigational applications in cardiovascular medicine. Mayo Clin Proc 70: 955-964, 1995.
Pomeranz B, Macaulay RJ, Caudill MA, Kutz I, Adam D, Gordon D, Kilborn KM, Barger AC, Shannon DC, Cohen RJ, and Benson H. Assessment of autonomic function in humans by heart rate spectral analysis. Am J Physiol 248: H151-H153, 1985.
Preckel B, Bolten J. Pharmacology of modern volatile anaesthetics. Best Pract Res Clin Anaesthesiol 19: 331-348, 2005.
Pypendop BH, Ilkiw JE. Hemodynamic effects of sevoflurane in cats. Am J Vet Res 65: 20-25, 2004.
Robinson BJ, Buyck HC, Galletly DC. Effect of propofol on heart rate, arterial pressure and digital plethysmograph variability. Br J Anaesth 73: 167-173, 1994.
Sano T, Nishimura R, Mochizuki M, Hara Y, Tagawa M, Sasaki N. Clinical usefulness of propofol as an anesthetic induction agent in dogs and cats. J Vet Med Sci 65: 641-643, 2003.
Scheffer GJ, Ten Voorde BJ, Karemaker JM, Ros HH, De Lange JJ. Effects of thiopentone, etomidate and propofol on beat-to-beat cardiovascular signals in man. Anaesthesia 48: 849-855, 1993.
Short CE, Bufalari A. Propofol anesthesia. Vet Clin North Am Small Anim Pract 29: 747-778, 1999.
Souza AP, Guerrero PN, Nishimori CT, Paula DP, Santos PS, De Rezende ML, Nunes N. Cardiopulmonary and acid-base effects of desflurane and sevoflurane in spontaneously breathing cats. J Feline Med Surg 7: 95-100, 2005.
Umehara S, Tanaka M, Nishikawa T. Effects of sevoflurane anesthesia on carotid-cardiac baroreflex responses in humans. Anesth Analg 102: 38-44, 2006.
Walker JR. What is new with inhaled anesthetics: part 2. J Perianesth Nurs 11: 404-409, 1996.
Win NN, Fukayama H, Kohase H, Umino M. The different effects of intravenous propofol and midazolam sedation on hemodynamic and heart rate variability. Anesth Analg 101: 97-102, 2005.
Zoran DL, Riedesel DH, Dyer DC. Pharmacokinetics of propofol in mixed-breed dogs and greyhounds. Am J Vet Res 54: 755-760, 1993.